Provider Demographics
NPI:1558850339
Name:DANCO SUPPORTIVE SERVICES COLORADO INC
Entity Type:Organization
Organization Name:DANCO SUPPORTIVE SERVICES COLORADO INC
Other - Org Name:MOMENTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:OWENSBY
Authorized Official - Suffix:
Authorized Official - Credentials:CAC II
Authorized Official - Phone:970-930-6355
Mailing Address - Street 1:3302 SOUTH GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601
Mailing Address - Country:US
Mailing Address - Phone:970-930-6355
Mailing Address - Fax:970-366-3929
Practice Address - Street 1:3302 SOUTH GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601
Practice Address - Country:US
Practice Address - Phone:970-930-6355
Practice Address - Fax:970-366-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1985-01261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder